Donors, recipients rely on nurses to help make life-changing choices

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WASHINGTON — It's two weeks before a huge domino kidney exchange, and a worried patient is calling Georgetown University Hospital. Is it really OK that she's lined up to get a kidney from someone two decades older?

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

To avoid bias, Hommel talks only with patients who need a kidney while her partner, Erin Burba, is the donor coordinator.

"My job is to protect the perfect health of a human being that we can only hurt," Burba explains. "Your life is in my hands."

While there's less than a 1 percent chance of death when donating a kidney in the U.S., Erin lays out every possible risk, from an infection caught in the hospital to the possibility that the person's remaining kidney might fail later in life.

The consent form is long. Donors even must meet with a social worker who explores their reasons for wanting to donate, and their expectations — especially the altruistic donors, who are offering a kidney to a stranger with no benefit to themselves or their own families.

Hommel gets to make the happy call: We found you a living donor who's a good match.

People who've been on dialysis a long time seldom hesitate, laughing in joy as they accept. But some patients need to think first, wondering if the match they're getting is really the best they can do.

On that Wednesday in November, Hommel gets ready to present the facts.

This retiree's kidney is in excellent condition, and highly compatible. The average patient survives five years on dialysis. The average wait for a kidney is five years. There's no way to predict when another match will appear, from either a living donor or the national waiting list for a cadaver organ — and how old that next kidney will be.

"This is your decision. It is your body. We would hope you would participate," she'll say.